Healthcare Provider Details

I. General information

NPI: 1821436007
Provider Name (Legal Business Name): EASTERN CONNECTICUT PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 TAMARACK AVE
SOUTH WINDSOR CT
06074-5562
US

IV. Provider business mailing address

2701 TAMARACK AVE
SOUTH WINDSOR CT
06074-5562
US

V. Phone/Fax

Practice location:
  • Phone: 860-375-5141
  • Fax: 860-896-8190
Mailing address:
  • Phone: 860-375-5141
  • Fax: 860-896-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GAYETHRI NARAYANSWAMY
Title or Position: PHYSICIAN
Credential:
Phone: 860-375-5141